Aims-To investigate the eVects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. Methods-VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the GriYths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). Results-Significant group diVerences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group diVerences in growth remained, but diVerences in cognitive outcome disappeared after five months. Conclusions-Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental eVect on long term cognitive development of VLBW infants than whether they are born SGA or AGA. (Arch Dis Child Fetal Neonatal Ed 2000;82:F208-F214)

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Blood volume was studied in 160 infants and children aged from one hour to 14 years. From these data linear and logarithmic regression equations relating blood volume to weight, height and surface area were calculated. Equations utilizing combined weight and logarithmic weight values were found to be the most accurate for predicting blood volume. Therefore, nomograms were constructed for reading blood volume directly from height and weight.

The effects of relying on outmoded IQ-test norms and the use of arbitrary classifications of developmental delay on estimates of cognitive impairment of very preterm infants (VPI) was evaluated in a prospective population study. Cognitive assessments included the Griffiths test at 5 and 20 months and the Columbia Mental Maturity Scales (CMM) and a vocabulary test (Aktiver Wortschatz Test, AWST) at 56 months of age. Rates of cognitive impairment of 321 very preterm infants (VPI; < 32 weeks gestation or < 1500 g birth weight) were determined according to the published test norms, to scores of a full-term control group (FC n = 321), and to scores from a representative sample of children (NC n = 431) of the same birth cohort. IQ-scores were higher in the FC and NC children than in the original standardisation sample (SS). Using the concurrent test norms (FC, NC) up to 2.4 times more VPI were identified as seriously impaired (<-2 SD) than if the published (outdated) norms were used. Serious developmental delay was underestimated when arbitrary (e.g. DQ < 70) rather than across age comparable definitions (DQ <-2 SD) were used. VPI study drop-outs had mothers with lower educational qualifications and poorer cognitive developmental scores at 5 or 20 months of age. In conclusion, a lack of appropriate control groups and use of arbitrary criteria for judging serious delay leads to large underestimations of cognitive impairment in VPI. Findings from previous uncontrolled studies of VPI need re-interpretation.

The co-morbidity of crying, feeding and sleeping problem at 5 months of age was investigated in a representative sample of 432 infants in South Gemany. A crying, sleeping or feeding problem was reported in 32.7% of these infants by their parents and a further 14.6% had two or more of these problems. Little comorbidity between crying and feeding problems was found. There were moderate to strong aswchtions between crying and sleepbehaviom. Feeding pmblems showed little relationship to sleeping behaviour, but feeding type and frequency of feeds were related to night waking. Breastfed infants woke much more often at night. Crying and feeding problems at 5 months were poor predictors of sleeping behavim at 20 or 56 months of age. Later sleeping behaviour was best pndickd by infant sleeping behaviour. At 56 months, m a t e d distress due to sleep@ and cogleeping practices was predicted by maternal distnss due to crying and feeding practices at 5 months of age. The prcdietions were significant but gmmally weak to modest in strength. Future studies on the consequences of crying or feeding problems should take into account patterns of co-morbidity. So-called 'post-colicky' sleep problems are not due to increased crying per se but rather appear to be the conmpnce of associated infant sleepin$ problems and parental carebkm g patterns for dealing with night Keywords: co-morbidity; colic; sleep problems; feeding; stability; waking in infancy. Continuity.The belief that crying, feedq and sleeping behaviom are related in infancy is held by both z !